Ebenezer Healthcare Services

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

067-R-1183 Issued in GA

Legal business name

EBENEZER HEALTHCARE SERVICES

Practice address

5380 Peachtree Industrial Blvd
Suite 247 Ab
Norcross, GA 30071-4713

Phone

(470) 299-4564

NPI assigned

Oct 12, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Myung S Song

Title

Owner

Phone

47029945464

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Ebenezer Healthcare Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ebenezer Healthcare Services, Inc.

  • In Home Supportive Care Agency
  • Norcross, GA
  • NPI 1669874673
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444608000000",
    "number": "1285005645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5380 PEACHTREE INDUSTRIAL BLVD STE 247",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300711592",
            "telephone_number": "470-299-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5380 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 247 AB",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300714713",
            "telephone_number": "470-299-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-12",
        "last_updated": "2015-10-12",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "MYUNG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "47029945464"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "GA",
            "license": "067-R-1183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003160947A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Durrance, LPC
• Ingrid Duva, RN
• Chad Ryan Dybdahl, A.T.C.
• Eastside Dental Group
• Easy Dental Care Center PC
• Ebenezer Healthcare Services, Inc.
• April Michelle Edwards, ARNP
• Ehi Pharmacy Solutions, LLC.
• Jennifer Elliott Ehrhardt, M.ED., CCC-SLP
• Mohamed Eid, O.D.

• In Home Supportive Care Agency in Norcross, GA
• Providers in Norcross, GA by specialty
• In Home Supportive Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.